Lumbar Fusion

What is wrong with my back?

You have one or more damaged discs and/or areas of arthritis in your back. This produces pain, and it may produce abnormal motion or misalignment of your spine. Discs are rubbery shock absorbers between the vertebrae. They are close to nerves that travel down to the legs. If the disc is damaged, part of it may bulge or even burst free into the spinal canal. These issues put pressure on the nerve and cause leg pain, numbness or weakness.

What is required to fix the problem?

Your condition requires both a nerve decompression (freeing the nerves from pressure) and a spinal fusion. In this case, both nerve decompression and spinal fusion would be done.

What is spinal fusion?

A fusion is a bony bridge between at least two other bones: in this case, two vertebrae in your spine. The vertebrae are the blocks of bone that make up the bony part of the spine, like a child’s building blocks stacked on top of each other to make a tower. Normally each vertebra moves within certain limits in relationship to its neighbors. In spinal disease, the movement may become excessive and painful, or the vertebrae may become unstable and move out of alignment, putting pressure on the spinal nerves. In cases like this, surgeons try to build bony bridges between the vertebrae using pieces of bone called bone graft. The bone graft may be obtained from the patient, (usually from the pelvis), or from a bone bank. There are advantages and disadvantages to either source. The bone graft is either laid next to the vertebrae or actually placed between the vertebral bodies. (The rubbery disc that normally lies between the vertebrae must be removed.) In either case, the bone graft has to heal and fuse to the adjacent bones before the fusion becomes solid. Spine surgeons often use screws and rods to protect the bone graft and stabilize the spine while the fusion heals.

How is the operation performed?

A four to five inch incision is made in the middle of the lower back. The spinal nerve is exposed, moved aside and protected. The ruptured disc or bone spur is removed to loosen the nerve. The spinal nerve is exposed, moved aside and protected, and the ruptured disc or bone spur is removed to loosen the nerve. The fusion is performed as described above. The wound is then closed and dressings are applied. The operation typically takes a minimum of three hours and may be longer, depending on the complexity of the problem. Sometimes the spinal fusion is performed with an anterior approach. In this case, the surgeon would make a four to five inch incision in the lower abdomen, gently move the internal organs aside, and proceed with the surgery as described above.

Who is a candidate for lumbar fusion, and when is it necessary?

When the back and nerve problems cannot be corrected in a more simple procedure and the pain persists at an unacceptable level, it is necessary to do a fusion. Instability of the spine may require a fusion. This may be necessary due to curvature of the spine or slippage of vertebrae. Some of the conditions which require spinal fusion are discussed in the answer to “What is Spinal Fusion?”

Who performs this surgery?

An orthopedist who specializes in spine surgery will perform this procedure.

Could I be paralyzed from surgery?

The chances of neurologic injury with spine surgery are very low. The possibility of catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is possible.

Are there other risks involved?

There are general risks with any type of surgery. These include, but are not limited to, the possibility of a wound infection, uncontrollable bleeding, leakage of spinal fluid, collection of blood clots in the wound or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the lungs), and heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure.

What are my chances of being relieved of my pain?

More than 90 percent of patients get relief of their nerve symptoms or leg pain. Relief of back pain is less predictable, occurring about 75 percent of the time.

Will I need to wear a neck brace?

Most patients will wear some type of neck brace after this surgery. The type of brace and length of time you need to wear the brace will be determined by your surgeon.

Will my back be normal after surgery?

No. Even if you have excellent relief of pain, the spine is not completely normal after a fusion. Stiffening one segment of the spine with the fusion may put additional strain on other areas. Other discs may have started to wear out. Even if they aren’t causing you pain now, they may do so in the future. For these reasons, you may have more back pain than someone without these spine issues. However, most people can resume almost all of their normal activities after their fusion has healed.

How long will I be in the hospital?

The hospital stay is generally one to three days.

What shouldn’t I do after surgery?

Generally, you should avoid bending, lifting and twisting for six to nine months. Even if screws or rods are used, six to twelve months are required for the fusion to heal completely. You must protect your spine during this time. Your surgeon will usually prescribe a brace for you to wear for part of this time. If you are a smoker, you definitely should not smoke until your fusion is completely solid, since smoking interferes with bone healing.

What can I do after surgery?

You should get up and move around frequently as soon as you feel like it. If you are feeling well enough, you may begin driving in two to three weeks with your back brace on.

When can I return to work?

This should be discussed individually with your surgeon. Generally, patients may return to sedentary jobs whenever they are comfortable, which is usually within three to six weeks. If you drive more than 30 minutes to get to work, your surgeon may want you to wait longer. It takes much longer to get back to work that requires strenuous physical activity due to the increased stress these activities place on the healing bone.

Could this ever happen to me again?

Unfortunately, yes. A fusion may add stress to the levels above and below the fusion. If the fusion doesn’t heal solidly, even with plates and screws, your symptoms may recur and additional surgery may be needed.

Should I avoid vigorous physical activity?

No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill are all examples of exercise that are appropriate for spine patients, but only when directed by your surgeon.